Bypass May Be Better for Diabetes

Coronary artery bypass surgery in diabetes patients led to better survival than angioplasty

(RxWiki News) People with diabetes are at risk of a number of cardiovascular problems, including blocked arteries. There's more than one kind of procedure that can restore blood flow, but which one works best?

When it comes to long-term survival, bypass surgery may be better than angioplasty for fixing blocked arteries in patients with diabetes.

"We recommend the surgical option to our patients with diabetes and significant coronary artery disease because bypass will promise them longer survival with a lower chance for return of angina (chest pain or discomfort from lack of blood to the heart) or additional procedures to address blockage," said Dr. Mohr.

"Ask your doctor about treatment options."

Rephael Mohr, MD, of Tel Aviv Sourasky Medical Center in Israel, and colleagues found diabetes patients who underwent a type of bypass surgery - called bilateral internal thoracic artery (BITA) grafting - had a 13 percent better survival rate than those who underwent two types of angioplasty surgeries.

If you have blocked arteries, blood and oxygen cannot flow to the heart as easily. If left untreated, blocked arteries can lead to heart attack and other serious problems.

Bypass surgery creates another path - called a bypass - for oxygen-rich blood to reach your heart. The surgeon takes a vein or artery from another part of your body and uses it to make the new path, or graft, around the blocked part of the artery.

Angioplasty is another procedure to restore blood flow to the heart. During angioplasty, a small tube with a balloon at the tip is guided through a blood vessel to the blocked artery. Once in the affected area, the balloon is inflated, pressing the plaque (the substance that blocks arteries) against the artery wall. This opens the artery to blood flow once again.

In many cases, patients who undergo angioplasty also get a permanent stent - a small mesh tube that helps keep the artery open and lowers the chance of it narrowing again.

In addition to finding bypass surgery patients had better long-term survival than patients who received stents, Dr. Mohr and colleagues found that patients who received stents were more likely to have repeated chest pain, additional procedures and non-fatal heart attacks.

According to the National Heart, Lung, and Blood Institute, people with diabetes have a higher risk of coronary artery disease and an increased risk of complications from procedures to treat coronary artery disease.

In people with diabetes, coronary artery disease can get worse faster than in those without diabetes. As Dr. Mohr explained, diabetes patients have smaller coronary arteries, which increases the risk of new blockages even after treatment with stents.

Dr. Mohr and colleagues found patients who underwent a type of angioplasty - called percutaneous coronary intervention (PCI) - had a lower chance of survival than those who underwent bypass surgery, with a hazard ratio of 3.01.

A hazard ratio explains how much an event happens in one group versus another. A hazard ratio of more than 1.0 means the event happens more in one group than the other.

PCI patients also had an increased risk of additional procedures for blocked blood vessels, with a hazard ratio of 7.0.

These patients will also have a lower risk of heart attack and heart-related death, Dr. Mohr added.

For their study, the Israeli researchers compared outcomes of 226 bypass surgery patients to those of 271 angioplasty patients.

The study was published in the Annals of Thoracic Surgery.

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Review Date: 
November 2, 2012